Friday, May 8, 2015

Medicine’s Future: Certainties and Instantneities

If a man will begin with certainties, he shall end in doubts; but if he is content to begin with doubts, he shall end in certainties.

Francis Bacon (1561-1626), The Advancement of Learning (1605)

Only two things are certain about medicine’s future: One, it will be digitally and data-based. Two, it will rest on instantaneous online information.
There are other certainties as well:

• Health care organizations, with the capacity to integrate clinical and financial information, will dominate.;

• the strength of these organizations will reside in their ability to produce “value”- better outcomes for less dollars;

• artificial intelligence, sometimes dubbed “computer cognitive skills, “ will make it possible to evaluate a person’s state of health and stage of disease at the point of care.

• virtual visits, as opposed to face-to-face, patient-to-physician visits, via telemedicine will be in vogue as a means of reducing costs, fostering consumer convenience, and erasing geographic barriers to care.

After having pointed out these certainties, I have my doubts that the digital revolution, so beautifully described in two 2015 books, The Patient Will See You Now: The Future is Your Smart Phone , Eric Topol, MD, Professor of Genomics at Scripps , and Robert Wachtner, Jr. , Professor of Medicine at the University of California in San Francisco, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Digital Age.

Both authors rank high among medical innovators,. They say digital medicine will transform medicine in fundamental ways and will level the playing field between patients and doctors by making information instantaneously available at a click of the mouse or a flick of a digit.

I have my doubts about the certainty of digital medicine transforming medicine for the better. To begin with, not all consumers are Internet- comfortable or competent. Secondly, there are privacy and identity security concerns, with no absolute protections against hackers. Thirdly, instant access through such sites as Facebook, Twitter, and Instagram creates cultural, political, and economic dilemmas and dislocations, as outlined in The Internet is Not the Answer(Atlantic Monthly Press, 2015). Fourthly, it is hard to distill the massive waves of information into human terms. And lastly, I believe the time is rapidly approaching when people will yearn for the good old days of simple doctor-patient interaction, direct charges for discreet fee-for-service individual services, and episodic personal care when needed or requested out-of-sight, off-line.

Hallmarks of technological change, creative destruction and disruptive innovation, may be best for most, but they leave victims in their wake. Most may endorse certainties and instant analytical documentation but others prefer conservative doubting and personal interactions. Tincture of time may be better than speed and promise of change.

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